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How Reimbursement Impacts the Safety Net Emergency Department after the ACA. A Case Study

Author: LA VONNE DOWNEY, DR LESLIE ZUN and AMANDA HONG
Published in JHHSA, Vol. 42 No. 1

Background – Payment source affects the amount paid to the ED for services rendered. The Patient Protection and Affordable Care Act (ACA) which was implemented in 2010 to help increase the quality and affordability of health insurance, lower the uninsured rate, and to reduce healthcare costs for patients and the government. Before the ACA, there had been an increase of financial strain in the Emergency Departments. This was due to three factors the passing of EMATA in 1986, the economic recession, and an increased number of uninsured and underinsured patients. If the Emergency Department (ED) has a more diverse payer mixture, they will receive a higher reimbursement ratio. The payer mix could change due to the requirement to obtain health insurance under the Affordable Care Act (ACA), This could have a positive impact on reimbursement rates for the ED.

Objective – The objective of this case study was to determine if there has been a change in the rate and type of reimbursement seen in a safety- net ED during the first five years of the Affordable Care Act (ACA). These findings could indicate how the ACA has or has not impacted a safety net ED’s

Methods – This was a retrospective, randomly sampled chart review of 1200 ED patients who presented to an inner city, level one adult and pediatric trauma center from 2010-2015. Data were analyzed using SPSS version 23, and the study was IRB approved.

Results – There was a relationship between types of insurance (payers) (p = .01) , and the dependent variables of payments (p= .01), and balance remaining after 90 days (p= .00). Since the implementation of the ACA, there has been a shift in methods of payment, with private third-party payers increasing from 3% in 2010, to 28% in 2015. There was also a decrease in the percentage of self-pay from 30% in 2010 to less than 10% in 2015and for Medicaid from 11% to 10%.

Conclusion – The results of this study indicate that this safety net ED reimbursement rates are positively associated with changes in payers during the first five years of the implementation of ACA. Thus, overall the ED reimbursement rates have increased post ACA for this safety net hospital. The positive association of a change in reimbursement rates for this safety net EDs indicates it might be impacted by how the ACA is or is not implemented currently and in the future.

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